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Commencing Volume 19, Issue 1, MedReviews has ceased the publication of this journal. Reviews in Cardiovascular Medicine will continue to be published by IMRPress, Ltd. (www.imrpress.com)

Volume 3, No 3 - Summer 2002

Volume 3, No 3 - Summer 2002

Table of Contents

Mitral Valve Replacement for Restenosis After Repeat Percutaneous Mitral Valvuloplasty
To what extent is prolapse of the mitral valve associated with mitral regurgitation and the risk of infective endocarditis, rupture of the chordae tendineae, and sudden death? Earlier studies used differing definitions and criteria, and reported prevalence of this deformity varied widely, especially between referral and general population studies. Advances in echocardiography have clarified the diagnosis, allowing classification of prolapse into subtypes associated with different degrees of risk and prognoses. [Rev Cardiovasc Med. 2001;(2)2:73–81]
Coronary Artery Calcium Scoring Using Electron-Beam Computed Tomography: Where Does This Test Fit into a Clinical Practice? Technique Update
Studies have indicated that the very early detection of a coronary artery burden is possible with electron-beam computed tomography (EBCT). However, both the Prevention Conference V and the ACC/AHA Expert Consensus Document on EBCT have recommended against the routine use of EBCT for screening for coronary artery disease in asymptomatic individuals. Moreover, there is no evidence so far to support using the results of EBCT in an asymptomatic patient to select a therapy or to guide referral to invasive investigations. The clinical role of EBCT is yet to be established in terms of screening for disease or risk assessment. EBCT is highly sensitive, but its specificity is low. In fact, when referral to angiography is based on the results of EBCT, referrals will be made for very few patients with normal results while many referrals will be made for those with abnormal results. The outcome will be that, in clinical practice, the observed sensitivity of EBCT will be increased, and the observed specificity will be reduced. To date, there are no well-conducted studies that clearly demonstrate the incremental value of calcium scoring over traditional assessments of risk factors, and the clinical role of EBCT is yet to be established in terms of screening for disease or risk assessment. [Rev Cardiovasc Med. 2002;3(3):121–128]
New Strategies in Managing and Preventing Atherosclerosis: Focus on HDL Prevention Update
The development of atherosclerosis is a complex process whose central elements include the entrapment of low-density lipoprotein in the vessel wall, its subsequent oxidative modification, and the stimulation of proinflammatory gene expression leading to inflammatory cell recruitment, infiltration, and activation. High-density lipoprotein interacts with this process at multiple points, and these interactions could provide therapeutic targets to prevent, stabilize, or even promote the regression of atherosclerosis. High-density lipoprotein may retard atherosclerotic progression by promoting cholesterol efflux from the arterial wall, thereby reducing plaque lipid content as well as potentially inhibiting nascent fatty streak formation. A growing body of evidence derived from clinical trials supports the contention that the raising of high-density lipoprotein levels may confer significant cardiovascular benefit independently of low-density lipoprotein lowering. An antiatherogenic strategy focusing on high-density lipoprotein and its apolipoproteins represents a new frontier in the management of atherosclerosis. [Rev Cardiovasc Med. 2002;3(3):129–137]
Angiogenesis Treatment Update
Several clinical trials of therapeutic angiogenesis in patients with coronary artery disease have shown clinical improvement and provided some objective evidence of improved perfusion and left ventricular function. Larger-scale, placebo-controlled trials, as well as studies of combinations of growth factors and the use of endothelial progenitor-cell or stem-cell supplementation, are in progress. Revascularization of ischemic myocardium with angiogenic compounds and without the mechanical manipulation of atherosclerotic vessels has great potential in the treatment of coronary artery disease. If it is proven to be both safe and efficacious, the revascularization of tissue biologically via medical or gene therapy will be a major advance in the treatment of patients with a diffuse disease that is not amenable to conventional therapy and in the augmentation of revascularization in patients undergoing traditional surgical therapies. [Rev Cardiovasc Med. 2002;3(3):138–144]
Unusual Presentation of an Acute Inferior Myocardial Infarction
There is a paucity of data on pseudoaneurysms of native coronary arteries; however, several reports exist on coronary artery aneurysms, which occur in approximately 1.5% of patients studied at autopsy or during cardiac catheterization. Patients can present with a wide range of symptoms from asymptomatic to sudden death. Complications include angina, myocardial infarction, fistula formation, spontaneous rupture, and distal embolization as a result of thrombus formation within the aneurysm. Treatment options include surgical ligation with coronary artery bypass surgery and implantation of a covered stent. Coronary anomalies and nonatherosclerotic coronary artery diseases should be suspected when a young patient presents with a myocardial infarction. Additionally, coronary aneurysm or pseudoaneurysm should be considered in patients with connective tissue disorder or the suggestion of connective tissue disorder. These entities may present as masses radiographically or echocardiographically. A high clinical suspicion is required for appropriate diagnosis and treatment. [Rev Cardiovasc Med. 2002;3(3):152–156]